HealthSmart Q & A-5

Dear HealthSmart,

I began hormone replacement therapy after having a hysterectomy in my early 50’s and continued for a total of 5 years. Now, I’m worried about its effects. What did the Women’s Health Initiative find?

HealthSmart asked Dr. JoAnn Manson, M.D., Chief, Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital. Here’s her response:

It is important to note that the Women’s Health Initiative study findings were largely misunderstood, and that hormone replacement therapy’s benefits and risks are largely individual and can vary with each patient. Additionally, the study only accounts for the effects of seven years of hormone estrogen therapy with a six-year post therapy follow up. There was no increased risk of breast cancer for the women followed in this study, the risks and benefits are very neutral. Among the women who were randomized in their 50s, and began the treatment in their 50s, they had a favorable balance of risks and benefits from their seven-year estrogen treatment, but did have a higher risk of blood clots. There is definitive evidence that hormone replacement therapy increases bone health and decreases a woman’s risk of bone fracture, which can prove very important in elderly populations.


Dear HealthSmart,

Who is a good candidate for statins? I hear a lot of friends and relatives say they’re on them, but have the inclination they may not need them.

HealthSmart asked Dr. Rita Redburg, Professor of Medicine at University of San Francisco School of Medicine and General Cardiologist. Here’s her response:

Only individuals who have a personal history of heart disease or have stints should be taking statins. Family history is not a determining factor for having heart disease or the need to take statins. Heart disease is defined as essentially anyone who has some narrowing in the arteries. I don’t recommend statins for an individual who simply has high LDL levels. If you’re concerned about prevention, there are more effective ways to reduce your risk of heart disease such as maintaining a healthy heart diet, not smoking, and getting plenty of exercise.


Dear HealthSmart,

I recently found out I’m pre-diabetic. I have a family history of diabetes and am very thin to begin with. I worry I have no chance at combating the onset of diabetes. What steps can I take to give myself the best shot at avoiding this disease? How does my situation differ from a pre-diabetic with no family history who is classified as overweight?

HealthSmart asked Dr. Xavier Pi-Sunyer, M.D., Professor of Medicine at Columbia University College and Chief of Endocrinology, Diabetes, and Nutrition at St. Luke’s-Roosevelt Hospital Center. Here’s his response:

Unfortunately having a family history or mutated gene predisposes an individual to diabetes. However, it’s important to remember that genetic testing for diabetes is not beneficial as there are too many genes involved, and there is nothing to be done about them. The fact that you’re not overweight, is an indicator that your beta cells have a much harder time producing and regulating insulin. Don’t assume that you’re at a total loss, because exercising will still aid in combating your pre-diabetes from turning into diabetes. Although it depends on the individual, we recommend 30 minutes of exercise five times a week at a minimum. Make sure to get your blood levels tested at least once every six months to monitor if your pre-diabetic status is advancing to diabetes. Pre-diabetic individuals with no family history and extra weight will have a much higher chance of combating the development of diabetes through lifestyle changes. Weight loss and increased exercise will ultimately provide their best defense. You have to be committed if you want to see results. People who lack the ability to change their lifestyle on their own often benefit greatly from structure – such as joining a weight management group or working with a nutritionist.


Do you have questions on health or wellness you’d like answered by the nation’s leading medical researchers? If so, you can send to HealthSmart is a national newspaper column from the Washington News Service in DC. Due to demand, we are unable to reply to all inquiries. Responses through the column are no substitute for care from physicians or other medical professionals.

Copyright Ellen James Martin 2021


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